Photos by Dr. Devin Gamundoy,
Story by Carol Sullivan, PhD
Consider the bow and arrow, and imagine yourself on the Pine Ridge Indian Reservation in South Dakota at the second annual health fair of the Rocky Vista University College of Osteopathic Medicine (RVU) May 3-4, 2019, after a six-hour drive from Denver.
The bow and arrow were crafted by native Americans for hunting and warfare. In The Lakota Way of Strength and Courage, Joseph M. Marshall III says that his ancestors practiced rituals to convey the power of the bow and arrow to transform living buffalo into food, clothing, sustenance, and to transfigure boys into men and connect all creation to “all the relations.”
Might this organic view of life be akin to osteopathic medicine? Imagine: The Lakota archer invokes the vitality of the bow that was hand-crafted from the living tree; he experiences nourishment and organic wholeness. In Engaging the Movement of Life, Dr. Bonnie Gintis emphasizes the treatment principle of the body’s self-healing process, its ability to ”create and renew, grow and change.”* The osteopath treats patients who heal in body and mind, a vitality akin to what Lakotas deem to be “all the relations.”
At Pine Ridge, a medical team sought to respect and learn from Lakota culture by offering a health fair as well as visiting several sites on the Reservation. Yet for the second year in a row, few patients showed up. Middle-school students as well as a handful of adult patients were seen.
Dr. Camille Bentley, Director of the Global Medicine Track, concedes, “Well we (RVU) tried again, and learned even more about the people and area of Pine Ridge. I am sorry for the lack of turnout for the Health Screenings, obviously the way NOT to go in the future.” The scant turnout is a stark contrast to Dr. Bentley’s 59 international trips. Whether to Kenya, Guatemala, or Ecuador, she has led programs that attract hundreds of patients to clinics in local communities.
What happened at Pine Ridge?
The health fair was staffed by thirteen RVU second-year medical students, three doctors, one administrative assistant, and two volunteers. Including screening, labs, leaflets, and education on child and adolescent health, adult women, and adult men, it was staged at Porcupine School and publicized as The Power of Community Health and Wellness Fair.
In addition, presentations for Porcupine students in the sixth, seventh, and eighth grades replaced thirty minutes of their customary instruction in science, mathematics, and language arts. RVU students handed out felt-backed pictures of various human organs—heart, liver, stomach, intestines, gall bladder. Mike Klepadlo wore an illustrative vest that showed the appropriate places for these organs. As students affixed each organ to the vest, they called out answers about its functions. In small groups, they used stethoscopes to listen to heart beats and abdominal sounds, checked each other’s reflexes, and used other tools in doctor bags.
A.J. Olson relished how much more medicine he knows at the end of his second year in contrast to his experience at a Pine Ridge pow-wow health booth last Labor Day. This time A.J. saw a patient whom he assessed from “head-to-toe,” and he felt comfortable in advising her about stress levels and sadness at the prospect of her oldest daughter leaving for college. He counseled her to set small goals such as walking more, eating more fruits and vegetables, and cutting back on intake of coca-cola. Affirming her parenting skills, he also taught her some breathing practices to relieve stress. She opened up more as she sensed that the clinic could offer her more than health screening.
In short, A.J. heeded instructions from Dr. Bentley to the team: “Take a step back and listen. In contrast to a 15-minute visit, there is opportunity to practice listening. Here you can hone your listening and observation skills, learn if and why the patient is scared, let the patient feel heard, and make a plan that fits the patient’s lifestyle.”
Gabe Bensaad saw a 20-year-old man who was having trouble hearing in his ear that had been elbowed during a basketball game. The congested ear was cleaned, and ear drops were recommended.
A patient, Julie Yellow Cloud, a Reservation native, attested that the screening/health consult that she underwent was extremely valuable, since she does not take leave from work to see a doctor for general health concerns; scheduling at a local clinic is difficult. Amanda Andersen took her health history, checked her blood sugar, examined her, consulted with Dr. Phil Sullivan, and used OMM to treat her back pain.
When no patients were there, Dr. Devin Gamundoy, an RVU professor of Family and Neurological Muscular Medicine, presided over student presentations and discussions on journal articles related to various health topics.
Jennifer Daniels described the case of a 38-year-old woman who wanted contraceptive advice. The patient had three children, all vaginal deliveries, and was interested in contraception, though she wanted to keep open the option of giving birth to another child. They discussed in detail a spectrum of options, their side-effects, and risks.
Conner Roggy summarized the case of a 52-year-old man whose father had died of a heart attack at age 74, and whose mother had hypertension. Discussed were the value of exercise, frequency and types of immunizations, and the benefits and risks of other health screenings such as PSA testing, colonoscopies, and EKGs.
Dr. Gamundoy encouraged questions, and observed that it could be valuable on future trips to include first as well as second-year students, so that second-years could mentor first-years, practicing collegial team-building and “taking the ego out of the equation.” He recalled that in his own residency, “I had more respect for my preceptors who guided me along rather than made me feel terrible about wrong decisions or not knowing.”
Dr. Phil Sullivan reviewed several case histories of patients he had seen during his 30 years of practice in the emergency room, and he emphasized the importance of the hands-on physical exam.
Vast Spaces, Cultural Biases, and Learning—Forever
Seeking to understand health care delivery on the Rez, RVU students visited Pine Ridge Hospital, part of the Indian Health Service. The 45-bed hospital serves a Lakota population of more than 17,000, and is the largest in the Great Plains Area. A 16-physician staff sees medical, obstetrical, pediatric, and surgical patients. It is set up for general surgery, an obstetrical ward, and dental care. The hospital lost its accreditation a few years ago, and is beset by high staff turnover.
A hospitalist, who was born in Syria, left his country ten years ago during the war and has worked at Pine Ridge Hospital for seven years: “This is a good place to learn. We are not overloaded. We have time to see patients. You see management from beginning to end.”
A pediatrician at the hospital told RVU students that he had been a “traveler” at other health facilities, that is, a provider who never practiced long at any one facility. Now he plans to stay in practice at Pine Ridge Hospital. He recognizes that he must break through a wall of patient mistrust again and again. “Patients don’t care about your ‘standard of care,’ and they don’t care that you care about their aftercare.” He persists in offering the best medical care possible: “I can dream—not just crisis management, [but also practice preventative and followup care, and nurture relationships that build trust, and better health].”
Reflecting on this pediatrician’s testimonial to his work, Zoe Gordon said that his passion comes not from doing “cool procedures” which specialists might provide in more standardized medical settings. “Cool things are not what it’s about,” Zoe said. “He sees that the people need genuine care. He just loves the population, and is truly in medicine to make a difference in kids’ lives, not for fame and fortune. It was refreshing to hear his story.”
In response to the immense challenges on the Reservation, a community cooperative is among the groups offering systematic positive change that is powered by residents. The RVU team met staff from Thunder Valley Cooperative http://www.thundervalley.org/live-rez/who-we-are. Andy Iron Horse, a former healthcare educator, is the cooperative’s “storyteller.” Thunder Valley has dared to dream and to build better housing, community development, and health care. Game-changers and stakeholders are invited “to the table.” Sharing a meal and conversation are leading to effective participation and decision-making from residents rather than outsiders. Yes, there is venting, Andy said, and there is conversation about solutions. Talk about what you would like to see, he advises, and what you can do to help and promote that, and then seek resources.
Another native-led organization is Oyate Teca Project. Executive Director Rose Fraser said that when she teaches gardening skills, she starts by finding out what the gardener wants to eat. On a bigger scale, a survey for the cooperative’s farmers market indicated that respondents had no interest in growing lettuce and spinach and opted instead for beets, potatoes, onions, carrots, green beans, squash, cucumbers, and zucchini. [Oyate Teca Project https://www.oyatetecaproject.org].
Rose said that while she welcomes volunteers from outside the Rez and shares her expertise and experience as a Lakota, she regards sweat lodge ceremonies and sun dances as “sacred times for our people,” rather than something to be shared. Pow wows are a venue where all are welcome. Several of the medical students, among them Austen Anderson, spent a sweaty afternoon at Oyate Teca; they cleared land, hoed, and planted seeds.
Offering OMM was Reese Beisser, who chose to sleep each frosty night in his tent; administrative assistant Molly Hunsberger coordinated events, and volunteer Keven Meyer served as an informal cultural ambassador.
Under the guidance of volunteer Carol Sullivan, the medical students practiced yoga in their spare time, including handstands taught by former gymnast Annie Szmanda.
Nicholas Chapman, AIG-RVU president, assessed this year’s RVU health fair: “To me, it makes perfect sense that we would have a low turnout, because we epitomize the issues people in Pine Ridge already have with health care professionals. I think that it is hard to build trust in a culture like this without demonstrating that you will be a lasting presence in the community. Hopefully we’re building something for future trips.”
Health, wellbeing, vast spaces, and building trust—where might an annual trip of medical students fit in the RVU curriculum and on the Reservation? Dr. Bentley states: “It appears that I will have to change the focus of our interventions in Pine Ridge to mostly health education, cultural exchange, historical exposure, and not so much a health fair.”
Having organized and participated in health fairs in big cities, Dr. Bentley observes a crucial difference at Pine Ridge: the vast spaciousness of the Rez. “ I REALLY understand now the problem with distance and everyone being so spread out. Also, everyone waiting for checks in the mail, so they can buy food, etc. two hours away [in Rapid City]. I continue to learn about my biases being a progressive city-girl by upbringing. As much as I am open to other cultures, being competent is understanding our own biases, then acting appropriately. This learning process goes on forever.”
Colby Presley, as with most of the medical team, has been on international medical trips. While preferring “back-to-back patients,” they may have gleaned something else. Starting in his early youth, Colby worked with his dad, a mortician, in embalming. “The body,” says Colby, “is a vessel, and the real body can get sick, but the person within does not. It’s super-beautiful to me.”
“Super-beautiful” might be an apt paraphrase of both Lakota and osteopathic perspectives on wellbeing.
As carloads of medical students, volunteers, and preceptors drove away, the land on the Reservation squinted back at them. Irrigation spouts mounted on the wheeled wings of silver pipes gleamed in the sunset, and recently-seeded fields of corn and onions lay silent in darkening shadows.
—Carol Sullivan, PhD
*Note: In Engaging the Movement of Life, Dr. Bonnie Gintis emphasizes the treatment principle of the body’s self-healing process, starting as an embryo and continuing in “adult living system[s] engaging as self-treatment” . “The body…has the ability to create and renew, grow and change.” If the practitioner considers that the embryo that created life also “innovates and adapts, then you may achieve a result beyond which [any] model [of health] predicts.” Rather than seeking a specific goal or biomechanical outcome, the osteopath uses the body’s unalterable midline in treatment “to bring back vitality…through movement and breath.”